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Gingivitis - Gum Disease

Know why that common gum disease is called “gingivitis”? Well, it’s because in medical terms, the gums are the gingiva. An “-itis” is an inflammation, so gingivitis is inflammation of the gums. Hence, gum disease. But we’re getting ahead of the story. To begin with, let’s talk about the gums themselves.

Our gums are part of the inner lining of the mouth. They’re what’s called “mucosal” tissue,  a type found in other body openings like the nostrils and eyes. One of the jobs of these mucosal tissues is to stop disease-causing agents from getting into the body. The gums do this by virtue of the seal they provide around the teeth. Gums are very tightly bonded to the underlying bone, too. Thus, even with the pounding they take on a daily basis they’re effective at protecting the deep tissues beneath them. The gums are also home to a network of special immune cells.  These put up an active defense of the physical barrier.


Effective, but not indestructible.  The enemies of our gingiva are inflammation and infection. In its milder stages, it’s called gingivitis. Thereafter, if it becomes more serious, it’s called periodontitis.  Periodontitis, as we’ll see, can become very serious, indeed.


It’s notable that gingivitis can progress pretty far before it begins to cause discomfort.

The usual early symptoms are red and swollen of the gums. Also, they may bleed easily. A putrid odor can develop, which some people say is like rotten meat. In time, the gums recede, exposing more of the teeth’s roots.

The most common cause of gingivitis by far is poor oral hygiene. Plaque that’s not removed promptly by brushing and flossing morphs into tartar.  Tartar (calculus) is harder and much more difficult to remove. Significantly, it penetrates under the gumline. This ratchets up inflammation of the gums. The longer plaque and tartar stay, the worse the irritation becomes. It’s all downhill from there.

The value of an individual’s oral hygiene practices depends on a number of factors. Life is not fair.  The same habits won’t work for everybody. There are many, many things that can make a person more likely to develop gingivitis. Aging, nutrition, tobacco use, misaligned teeth, genes, hormonal changes, various medications, anything that causes dry mouth – all increase the risk. People with any of these risk factors need to be more diligent about self-care than others do.


Gingivitis is very manageable when caught at an early stage. In fact, regular dentist checkups and cleanings are the first-line professional intervention. Office cleanings remove tartar, which home care can’t. Any caries that have developed get filled. Patients should make dentists aware of any special risk factors they’ve got.  When an individual has cleanings often enough and practices good self-care, the risk of gingivitis developing is minimal.  So far, so good.


Left alone, however, gingivitis can develop into the much more serious gum disease called periodontitis. Gingivitis won’t always progress to periodontitis, but periodontitis is always preceded by gingivitis. Added symptoms include painful chewing, loose teeth, new spaces between teeth, pus, and changes in bite. At this point, damage and destruction of soft tissues and bone are underway. People with a genetic predisposition sometimes have rapid progression to tooth and bone loss. Likewise, those with compromised immune systems are prone to severe infections.

The common chronic periodontitis, untreated, progresses to tooth and bone loss, too. Worse yet, the germs that cause gum disease can get into the bloodstream. The evidence now connects these bacteria to stroke, coronary artery disease, respiratory disease, and rheumatoid arthritis.  Links to dementia are being explored.


Simply put, periodontitis has one cause: gingivitis. Therefore, prevention is all about keeping gingivitis at bay. Solid self-care plus regular, timely dentist visits are the name of the game.

The goals of treatment depend on the stage of the disease. In less advanced cases, the focus is on keeping things clean and halting tissue damage.  Dentists sometimes prescribe oral antibiotics to control infection. One of the screenings for periodontitis involves measuring the depth of gumline pockets with a probe. These are normally 1 – 3mm deep.  At 4mm, it’s a red flag for periodontitis. At depths of 5mm or less, dentists have two treatment options. Scaling, cleaning above and below the gumline with a metal tool, removes plaque and tartar. Root planing smooths the root surface, making it easier for the gum to re-bond with the tooth.

Pockets 6mm or deeper are can’t be cleaned. At this stage of the disease, more radical treatment options have to be considered. Surgical options.

Periodontal surgeons can go deep below the gumline. They slice into gums and peel the soft tissue back to expose the roots. After scaling and root planing, the surgeon stitches the cuts closed. Damaged gums can be repaired with grafts of tissue taken from other areas inside the mouth. Likewise, surgeons perform bone grafts to restore structures around a tooth root. Finally, other techniques involve the insertion of mesh guide bone re-growth.


Chronic periodontitis affects just under half of the adults over the age of 30 in America. This is a grim statistic. There’s no good reason for it.  We know what causes it, we know how to prevent it, and we know how to stop progression from gingivitis. Therefore, gum disease should not be epidemic. And yet, about 30% of Americans in the 65-74 age group have no natural teeth left at all.

A landmark 2014 study for the Health Policy Institute of the American Dental Association sheds some light on this puzzle. Cost turns out to be the most common reason adults give for not seeking dental care. One of the other top excuses was “don’t need it”. However, the toothless statistic strongly suggests we do need it.

The cost excuse is likely related to perceived need. It’s true that dental care costs money. It always costs, it’s never free. Even when patients are not the payers, somebody’s paying the bill. Pro bono dentists in free clinics are paying themselves. They’re giving up what they could be earning. For some reason, an awful lot of us don’t want to spend money on dental health. Accordingly, we believe we don’t need to.


In the final analysis, it comes down to priorities. We do spend lots of money on things that have no impact on our health and well being. Sadly, we’re able to convince ourselves that we don’t need dental care, when in fact, we do. However, the day comes when we can’t ignore it anymore.  As a result of our delay, treatment costs are much higher. Also, the delay often results in very much worse outcomes. Why do we allow dental emergencies to develop needlessly?

Dental care is health care. Everyone needs it. People need to accept that premise. Priorities would change and outcomes – including wallet outcomes – would improve. Gum disease is a perfect example of the benefits of a modest effort at prevention. In summary, have regular timely checkups and cleanings, prompt treatment when required, and good daily hygiene. After all, when we think of the alternatives, it’s no trouble at all.